Concerned about Glucose Spikes

[chrisonator70]

Hey all, I have always been a health anxious person, but I am concerned that I may have an actual issue this time. I recently bought a glucose meter to check my blood sugar because I sometimes get episodes of feeling tired and having heart palpitations right after meals, and then about 4 hrs after eating I get really shaky. I found that some of my readings were normal, spiking only to about 150 or so after a meal and quickly dropping to fasting levels, but a few times per week my blood sugar spikes up to about 235 mg/dl for an hour or 2 after a meal and then drops to about 50-60 a couple hours later. These episodes coincided with my symptoms and leave me feeling drained. My fasting glucose is normal, at about 87 mg/dl most days. My A1C was also only 4.8% at my last routine physical 6 months ago. I'm concerned that these episodes could be a sign of an early stage of diabetes because type 2 and heart disease runs in the family, but I'm also a healthy 20 year old and my weight is actually low-normal, which seems to make type 2 unlikely. Most family members seem to think I'm just worrying too much but 235 mg/dl (13.1 mmol/L) seems a bit high for a non-diabetic spike, and the readings in the 50s (around 3.2 mmol/L) seem a little low. Any thoughts? Am I just being a worrier, or is it worth pushing my doctor for more tests?

 

[JoKalsbeek]

Hey all, I have always been a health anxious person, but I am concerned that I may have an actual issue this time. I recently bought a glucose meter to check my blood sugar because I sometimes get episodes of feeling tired and having heart palpitations right after meals, and then about 4 hrs after eating I get really shaky. I found that some of my readings were normal, spiking only to about 150 or so after a meal and quickly dropping to fasting levels, but a few times per week my blood sugar spikes up to about 235 mg/dl for an hour or 2 after a meal and then drops to about 50-60 a couple hours later. These episodes coincided with my symptoms and leave me feeling drained. My fasting glucose is normal, at about 87 mg/dl most days. My A1C was also only 4.8% at my last routine physical 6 months ago. I'm concerned that these episodes could be a sign of an early stage of diabetes because type 2 and heart disease runs in the family, but I'm also a healthy 20 year old and my weight is actually low-normal, which seems to make type 2 unlikely. Most family members seem to think I'm just worrying too much but 235 mg/dl (13.1 mmol/L) seems a bit high for a non-diabetic spike, and the readings in the 50s (around 3.2 mmol/L) seem a little low. Any thoughts? Am I just being a worrier, or is it worth pushing my doctor for more tests?

Read up a little on Reactive Hypoglycemia. It's when your blood sugars spike, and your pancreas overreacts by pumping out more insulin than you actually need. Treatment for it is basically the same as it would be for Type 2 diabetes: A low carb diet. Because if there are no spikes, there are no overreactions from your pancreas either. Mind you, not all T2's have had RH before diagnosis, and not all RH's become diabetics. But it does mean you put out a lot of insulin, so insulin insensitivity (and T2) is something you want to avoid in the long run. You can do that by making changes now, because yeah, your spikes are a bit too high. (Shouldn't be over 8,5 mmol/l or 153 mg/dl)

You can get tested for RH with an extrended oral glucose tolerance test (OGTT), and you'll want the extended one, so you don't end up with a low when they've already stopped testing. If you don't want to go to hospital in these times though, just try changing your diet and see whether that solves the problem.

https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help you along.
Good luck!
Jo

 

[chrisonator70]

Yes that does sound like a possibility, although I only go low maybe half of the time that these spikes happen, and my real concern is with the spike itself, because eating some carbs tends to fix the low. I just called one of my university's doctors about it and he said that maybe another consideration would be LADA and that I should probably get a GAD antibody test as well as a c-peptide test to check for it. He also said anything relating to type 2 would be unusual at my age and BMI, and apparently I should stop checking my blood sugar so much because my health anxiety is "out of control". I have scheduled an online appointment with my usual GP upon the recommendation of the doctor at the university's clinic because that testing at my university is very expensive out of state with my insurance. Thanks for the help!

 

[JoKalsbeek]

Yes that does sound like a possibility, although I only go low maybe half of the time that these spikes happen, and my real concern is with the spike itself, because eating some carbs tends to fix the low. I just called one of my university's doctors about it and he said that maybe another consideration would be LADA and that I should probably get a GAD antibody test as well as a c-peptide test to check for it. He also said anything relating to type 2 would be unusual at my age and BMI, and apparently I should stop checking my blood sugar so much because my health anxiety is "out of control". I have scheduled an online appointment with my usual GP upon the recommendation of the doctor at the university's clinic because that testing at my university is very expensive out of state with my insurance. Thanks for the help!

With a low carb diet you'd have no spikes and no lows. You'd even out and feel a whole lot better. If you fix the lows with more carbs you keep bouncing your blood sugars around, which isn't good. And while health anxiety is a thing, considering the numbers you're seeing... You have a *reason* to test. Your spikes are considerable, so I'm puzzled at the doc's response. "Get C-Pep and GAD done" sounds like he's taking it seriously, then tells you not to test yourself? If he's concerned about LADA, that's kind of weird. Do get more tests done, (the ones mentioned, eOGTT, C-Pep and GAD), because you shouldn't see spikes like you are. And the lows, well... They might not concern you now, but just wait until you pass out and land on your camera at an event with 30.000 people. (The zoomlens didn't survive, the bruises hurt, and my pride took a beating because with a gazillion lookeyloos, and the inability to get up for about forever, I was a freakshow). Just lucky I don't drive, I could've killed someone. I know this is not the thing to say to someone with health anxiety, but not every fear we humans face is imagined. Get checked, because *if* something is wrong, there ARE solutions out there.

Take care of yourself eh.
Jo

 

[chrisonator70]

Yes, I do agree about the lowering of the carbs in my diet, and I have already reduced them quite significantly and essentially eliminated the refined ones and sugars. The doctor didn't tell me to stop testing, but just that I was probably doing it a bit too much. I think he was also taking into account my previous anxiety and obsession with blood pressure checking and probably didn't want me to get too panicked about it. I'm pretty sure the reason he was thinking LADA and not insulin resistance was due to my age and BMI, as well as having ideal triglycerides and HDL that don't align with it. I have a video appointment (because of COVID) with my usual primary care doctor in a few days and I am certainly taking it seriously. Thanks for your responses!

 

[chrisonator70]

So I ate 2 small whole grain waffles today (about 35-40 g unrefined carbs total) hoping that the lack of refined carbs would be enough to limit the spike. Unfortunately it was not, and my glucose spent a couple of hours around 220 mg/dl (12.2 mmol/l), although there was no low this time. It almost seems like I'm approaching pre-diabetic levels even with whole grains. I guess I should even cut back on the so called "healthy" grains. So far it does seem that berries are alright though.

 

[JoKalsbeek]

So I ate 2 small whole grain waffles today (about 35-40 g unrefined carbs total) hoping that the lack of refined carbs would be enough to limit the spike. Unfortunately it was not, and my glucose spent a couple of hours around 220 mg/dl (12.2 mmol/l), although there was no low this time. It almost seems like I'm approaching pre-diabetic levels even with whole grains. I guess I should even cut back on the so called "healthy" grains. So far it does seem that berries are alright though.

Like I said, practically all carbs turn to glucose once ingested (the exceptions are mainly sugar alcohols, they don't penetrate the bowel wall). Any other carb, be they brown, white, wholemeal or supposedly healthy, can and will spike bloodsugars if you're susceptible. So refined or not... Doesn't really matter all that much. Sorry. And yeah, berries are cool that way. (They'll spike you even less if you take them with cream or full fat greek yoghurt!)

 

[chrisonator70]

Yes, I am finding that too with the grains. It's actually quite surprising that fruit is so acceptable though. For example, at breakfast this morning I had an omelet and a fruit (mostly frozen berries) smoothie with peanut butter and unsweetened coconut/almond milk and my blood sugar barely even spiked to 135 at it's peak. You had mentioned that fats can help so maybe it was due to the fat in the peanut butter and coconut milk? Whatever the reason, I'm fairly happy with that type of breakfast and if it helps keep my glucose normal and my arteries free of plaque than that's a good thing. As an added bonus I felt great after this breakfast and had consistent energy, unlike with the grains. I guess I just don't understand why things like whole grains are recommended for type 2 diabetics by the ADA and other organizations if they are so problematic for Impaired glucose tolerance. Wouldn't a type 2 need to limit the carbs even more aggressively? Unless there are just very polarizing opinions for and against low carb? I can't see how the spikes could ever be healthy! They certainly don't feel pleasant. Thanks for your help on this. I will also post an update after my doctors appt. tomorrow.

 

[JoKalsbeek]

Yes, I am finding that too with the grains. It's actually quite surprising that fruit is so acceptable though. For example, at breakfast this morning I had an omelet and a fruit (mostly frozen berries) smoothie with peanut butter and unsweetened coconut/almond milk and my blood sugar barely even spiked to 135 at it's peak. You had mentioned that fats can help so maybe it was due to the fat in the peanut butter and coconut milk? Whatever the reason, I'm fairly happy with that type of breakfast and if it helps keep my glucose normal and my arteries free of plaque than that's a good thing. As an added bonus I felt great after this breakfast and had consistent energy, unlike with the grains. I guess I just don't understand why things like whole grains are recommended for type 2 diabetics by the ADA and other organizations if they are so problematic for Impaired glucose tolerance. Wouldn't a type 2 need to limit the carbs even more aggressively? Unless there are just very polarizing opinions for and against low carb? I can't see how the spikes could ever be healthy! They certainly don't feel pleasant. Thanks for your help on this. I will also post an update after my doctors appt. tomorrow.

I cancelled my support of the Dutch diabetes association when their magazine had a cover article about a high tea. A "proper" one, loaded with carbs. More of them than I eat in about 2 weeks (i'm hovering at about 10 to 20 grams of carbs per day). I'd been on their forum for a while and what I was doing was indeed "controversial". And I was also one of the extremely few who actually didn't put up terrified posts whenever a blood test was done. In my GP's practice I'm still the only one who's normalised her bloodsugars through diet and am without medication, because everyone there gets sent to the same dieticians, and they still advocate high carb, low fat. (They've got the right books on the shelves, they just don't seem to have read them). The whole "carb good, fat bad" thing is based on very, very outdated research done decades ago, which was actually paid for by the US food industry, somewhere in I think the 60's of the last century? I am no good with numbers, can't remember when exactly. But the research, which was biased and dubious at best, was taken up all over the world. Which is why now, there's a couple of generations where diabetes is way more prevalent than it was in, say, 1940, when people were still perfectly fine with lard.

With fruit, it depends entirely on how much fructose is in there. Berries with fats are fine, others... Not so much. https://www.dietdoctor.com/low-carb/fruits See?

Keep figuring stuff out, keep asking questions, keep on taking care of yourself.
Jo

 

[chrisonator70]

Alright, so I had an appointment with with my primary care doctor today. He wasn't super concerned about the spikes because they always come back down eventually, but he did order another A1C test as well as a fasting insulin level test. He recommended against the antibody tests and c-peptide because they are not necessary yet, but he will apparently refer me to an endocrinologist for those eventually if my blood sugars get high enough to warrant treatment beyond diet modification. He recommended that I cut back on eating the foods that were causing me problems like sugar and starch, as well as stop checking my blood sugar as often. So it looks like my plan is to get those labs done, keep cutting back on the carbs, stop pricking my finger so much after every single meal, and just generally try not to be so panicky about my health. Thanks for all your help and input!